Using Emotions as a Pathway for Change

Transcription

1 Using Emotions as a Pathway for Change A review of the video Emotionally Focused Therapy With Couples (2007). with Leslie S. Greenberg Washington, DC: American Psychological Association, American Psychological Association Psychotherapy Video Series (Series IV: Relationships), Item No $99.95 Reviewed by Phyllis Erdman Emotionally focused therapy (EFT) was first introduced in the 1980s by Susan M. Johnson as a response to the need for a more clearly validated approach toward couple therapy that recognized the couple's emotional system as a possible tool for change. Prior to EFT, therapeutic interventions with couples tended to be more behavioral and less humanistic; hence emotional exchanges, particularly negative emotions, were viewed primarily as a part of the problem rather than as an agent of change. Although affective changes were recognized as a requisite of relationship repair, the tendency was for these changes to

2 occur as a secondary gain to cognitive and behavioral changes. With EFT, affect regulation becomes the focus of therapy rather than the outcome, because the emotional system is viewed as the pathway for understanding and facilitating behavioral changes (Johnson, 1996; Johnson & Greenberg, 1994). Within the last decade, the basic tenets of attachment theory have served as a framework for supporting the therapeutic process of EFT, and research based on this approach has been well documented in the literature. (For a complete list of publications on EFT, the reader should visit the Maryland Center for EFT at resources.html.) Two primary figures who have led this movement have been Susan M. Johnson and Leslie S. Greenberg. Greenberg discusses this theoretical base in the video Emotionally Focused Therapy With Couples, which is part of the American Psychological Association Psychotherapy Video series (Series IV: Relationships), hosted by Jon Carlson. The video begins with an interview of Greenberg by Carlson, during which Greenberg explains how his original training with the Mental Research Institute (MRI) group and his background in experiential-based work with couples provided the catalyst for his transition to a more affect-based approach. Greenberg succinctly describes his approach in the video as affective regulation and explains that problems arise in couples because many of the core emotions in individuals are not being expressed to their partners. The role of the therapist, then, becomes that of an emotional coach to help each partner bring out the best emotions in themselves and to help teach them to share these emotions with each other. However, frequently these emotions are blocked by previous negative experiences. Greenberg explains how his approach focuses on the positive emotions, such as expressions of caring and love, as well as the negative emotions, such as fear, shame, and hurt. He describes how these negative emotions frequently interfere with a couple's ability to openly express the positive emotions.

3 Theoretical Base of EFT When asked about the theoretical base for his approach, Greenberg explains in the video that previously he integrated experiential (client centered and Gestalt therapy) and systemic (interactional) concepts, but more recently his thinking has been influenced by affective neuroscience, which he explains as thinking about how emotions work. He admits that attachment is important and reflects on work by his colleague, Susan M. Johnson, who places more emphasis on attachment needs as the basis for emotional interactions. Greenberg, however, explains in the video that he is interested in a more fundamental level of understanding emotions than just attachment, which he refers to as affect regulation. In support of this, he references The Emotional Brain (1996) by LeDoux in which LeDoux explains the brain as having two levels of emotion the first is a gut level or reactive response, and the second is a reflective response. Greenberg describes affective neuroscience as the ability to help couples understand how they express emotions, how they reflect on those emotions, and what difficulties exist in affective interactions between them, and he emphasizes that his approach with EFT is a process theory. It is at this point in the video that a more thorough explanation of how Greenberg's conceptualization of EFT differs from Johnson's would have been helpful for the viewer. Although Greenberg acknowledges that attachment theory is relevant, he emphasizes that he really defines EFT as a process theory. However, he fails to describe clearly how this differentiates from Johnson's conceptualization of EFT, because both adhere to EFT as a process therapy. This lack of differentiation between the two approaches leaves the viewer rather confused. Following the interview in the video, Greenberg introduces a couple with whom he will be

4 working and then transitions into the actual session. This is particularly helpful because the viewer can observe how Greenberg tries to identify the problem, asking both partners what the problem looks like, but then exploring each one's emotions around the problem. He then follows with questions that explore the couple's interactions, and consistently checks with each partner on how the dialogue is affecting them emotionally. This is skillfully done by Greenberg in a very gentle and person-focused approach. He is a master of listening skills and reflection during this process. Greenberg then helps both partners independently try to identify their fears with questions such as, What do you really need at this point from him? to the female partner, while suggesting that the male partner should just really listen to her now. This clearly represents the three-part process of therapy, which he explains as first, to reveal underlying vulnerable feelings to the partner; second, to learn how to sooth the partner's emotions; and third, to follow with corrective emotional expressions. Greenberg moves the couple through this process rather rapidly, particularly when it is apparent that they are both struggling to identify their emotions and reactions. He often provides suggestions for them about how each might feel, with comments such as What is it that you're feeling when you vent? Really angry? Angry at him? Angry at the world. Would you agree? He then follows up by helping the couple to develop a more corrective interaction cycle by suggesting they try questions such as, If you could really be there for me, what I want you to do is understand. What I'm really frustrated about [is]. What would happen if you could just say.? In a real case, this process would most likely take much longer, so in a sense it seems to be fast forwarded. However, the advantage of this is that the viewer can easily see the process occurring: It becomes alive rather than an abstract concept. Greenberg skillfully moves back and forth between both partners, so neither is left feeling invalidated. Questions such as Can you tell her what you really need from her and what makes it so

5 difficult to be able to ask for that? are examples of how basic attachment needs are infused into his conceptualization of the case throughout the therapy session. At the conclusion of the session, he facilitates each partner's ability to expose his or her vulnerabilities in a safe environment and ensures that both have been validated, helping them engage in a more positive interactive cycle. There seems to be an assumption at the end of the session that the couple will be able to internalize this process after they leave the session, which may be a bit unrealistic. Hence, the session ends rather abruptly. The next part of the video is a discussion of the session with Jon Carlson. Greenberg provides a rationale for his questions and the expected gains. This is followed by a repeat of the session, with a background explanation of Greenberg talking through his approach, again with rationale and explanations for his questions. This is one of the most valuable sections of the video because Greenberg explains how he helped the couple move from talking about family issues to their own interactions. He also explains how one series of questions led him in a direction that he thought would be less helpful and then redirected them in a different direction. Summary This video is designed to help clinicians and students in training understand the concepts of EFT and how to apply them. As with EFT, the process may appear easier to implement when listening to an expert than it really is. Basic therapeutic listening skills, reflecting, and validation are key components to successful EFT, as well as trusting in the process. Exposing feelings of vulnerability can be threatening to many inexperienced clinicians and can be more harmful than helpful if not contained in the therapeutic process and redirected into more positive exchanges. Greenberg does discuss the situations for which

6 EFT would not be recommended, such as couples experiencing violence, couples with serious personal problems, or couples who engage in attacking or blocking each other. Overall, the video is professionally illustrated, and Greenberg artfully applies the techniques of EFT. The format of the video is particularly helpful, because the viewer learns about the theoretical base for EFT, views a session followed by an explanation of the session, and ends with a repeat of the session with a background explanation by Greenberg. References Johnson, S. M. (1996). The practice of emotionally focused marital therapy: Creating connection. New York: Brunner/Mazel. Johnson, S. M., & Greenberg, L. S. (Eds.). (1994). The heart of the matter: Perspectives on emotion in marital therapy. New York: Brunner/Mazel. LeDoux, J. E. (1996). The emotional brain. New York: Touchstone. PsycCRITIQUES August 15, 2007, Vol. 52, Release 33, Article , American Psychological Association